| Doctor Name: | MRS. MARY GARDNER SULLIVAN |
| NPI Number: | 1336357987 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.I.C.S.W. |
| License Number: | 114161 |
| Business Practice Address: | 923 Route 6a Suite T Yarmouth Port, MA - 026752159 |
| Business Phone Number: | 5086540905 |
| Business Fax Number: | |
| Mailing Address: | Po Box 295, YARMOUTH PORT |
| State: | MA |
| Postal Code: | 026750295 |
| Phone Number: | 5083627167 |
| Fax Number: | |
| NPI Enumeration Date: | 05/18/2007 |
| NPI Last Update Date: | 10/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 114161 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |